Kids Health Info

Brain Injury - Seizures after an Acquired Brain Injury

  • It is quite common for children who have had a brain injury to have a seizure (fit, or convulsion) soon after their injury. Sometimes medication (anticonvulsant) is needed to help prevent further seizures. During a seizure, the most important thing to remember is to keep your child's airways open.

    What are seizures?

    Seizures occur when the normal electrical signals within the brain misfire. They usually affect a child's awareness of their surroundings or their actions for a short period of time. The electrical signals usually return to normal within a few seconds or a few minutes and the seizure will then stop. Seizures usually occur without warning and without the child being aware of what is happening. Medications are often prescribed to help prevent further seizures. This medication is often given directly into the veins (intravenous or IV) to allow it to act quickly. After the child becomes more aware and is swallowing safely they can take tablets or syrup. If seizures continue to occur, anticonvulsant drugs will need to be given for a longer period of time.

    Types of seizures

    There are several different types of seizures. Generalised seizures happen when the whole brain is misfiring, and partial seizures when one part of the brain is affected. Some of the most common types of seizures are:

    • Generalised seizures - Convulsive seizures (known as tonic-clonic or grand mal seizures); children may give a sudden cry, lose consciousness, fall, wet or soil themselves and shake all over.
    • Absence seizures - (known as petit mal seizures); children stare blankly without losing consciousness, blink quickly, may make chewing actions or show twitching of their facial muscles.
    • Partial Seizures -
      (a) Simple partial seizures - The child may experience abnormal sensations or movements of a part of the body while they remain awake.  One part of the body, for example an arm, a leg or the face, may jerk.
      (b) Complex partial seizure - These begin with a one to two minute period during which the person loses their awareness of their surroundings. It is similar to an absence seizure, but it is followed by random actions such as picking at clothing. These seizures are often followed by a period of drowsiness.

    Diagnosis of epilepsy

    It is important to carefully observe the child's behaviour at the time of the suspected seizure. The observations should include:

    • what the child was doing at the time (eg watching TV, going to sleep)
    • what happened during the episode
    • how long the episode lasted
    • what the child was like afterwards

    Some specific tests will help determine the cause of the seizures. The number and types of tests used to diagnose epilepsy are different for each patient. An electroencephalogram (EEG) is a test that measures electrical activity in the brain and is frequently used to help diagnose epilepsy. Some other common tests include CAT and MRI scans. It may be necessary for some children to be sedated so that these scans can be done accurately.

    Treatments for epilepsy

    Once it is decided that a child requires treatment for their seizures, medication is prescribed. The type of drug will depend on the type of seizures (generalised or partial). If possible, a single drug, such as carbamazepine, valproate, gabapentin, phenytoin, topiramate or lamotrigine, is given. Most children will respond well to medication. Anticonvulsant medications are usually very effective. Sometimes they may have side effects such as drowsiness and weight gain. Some children will also need to be checked with follow up blood tests.

    New interventions

    Surgery for epilepsy in children is considered only in those who are not helped by medication and whose seizures severely affect their quality of life and development. Surgery is done only in carefully selected patients, usually those with a known focus (part of the brain) that is responsible for causing the seizures.

    Talking to your child about epilepsy

    Some ways you may help your child more fully understand their condition are to:

    • Listen to your child's feelings of frustration, anger, fear or guilt.  Reassure them that it is not their fault.
    • Explain, in terms your child can understand, what happens during an epileptic seizure, how treatment will help and what they should do when a seizure occurs.
    • Assure your child, if they ask, that it is extremely rare for someone to die during a seizure.
    • You may wish to introduce your child to other children with epilepsy.
    • Emphasise your child's abilities and talents.
    • Talk openly about epilepsy and your child's treatments so that family and friends are made to feel more comfortable with the condition.

    During a Seizure

    • The major task when your child has a seizure is to keep their airway open so the brain can get normal amounts of oxygen.
    • Your child's lips will be blue in colour if they are having trouble breathing. This might mean that their airway is blocked.
    • Place your child on their side to allow the mouth contents to drain and the tongue to fall forward.
    • Remember, a child will NOT swallow their tongue. If your child vomits, quickly clear their mouth if it is possible. It is NOT necessary to force anything into their mouth. You may injure yourself unnecessarily if you force your fingers between their clenched teeth.
    • When your child is breathing without difficulty, place them on the ground or floor in a safe area. Move all objects away and place cushions around their head if possible.
    • Loosen any tight clothing.
    • Do not restrain their movements.
    • Call your child's doctor.
    • If breathing is troubled, or the seizure lasts longer than a few minutes, you should call 000 for an ambulance. 

    After the seizure, your child may fall into a deep sleep. This is normal so do not try to wake them. Do not attempt to give any food or drink until they are awake and alert.

    Following a seizure, particularly if it is a first or unexplained seizure, call your doctor or emergency medical service for instructions. Your child will usually need to be evaluated by a doctor as soon as possible.

    See Kids Health Info factsheet:  Seizures - safety issues and how to help

    Key points to remember

    • It is quite common for children who have had a brain injury to have a seizure soon after their injury.
    • There are medications that can help prevent the occurrence of seizures.
    • It can be helpful to talk to your child about their seizures.
    • The most important thing to remember when your child has a seizure is to keep their airways open.

    If breathing is troubled or the seizure lasts longer than a few minutes you should call 000 for an ambulance.  

    For more information

    Developed by the RCH Paediatric Rehabilitation Service. First published in March 2007. Updated November 2010.


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.